In the 10 years I have been on the UCSF faculty, I have developed an independent program focused on three major areas of interest: 1) Understanding how care systems might be best arranged to improve both quality and outcomes of healthcare, such as how cardiologists or hospitalists might affect outcomes of patients with congestive heart failure; 2) Understanding how improve use of beta-blockers in noncardiac surgery as a way to reduce cardiac morbidity, and 3) Improving our ability to measure the quality of healthcare and implement change effectively. My work has placed a particular emphasis on the management of patients with cardiovascular illness who are undergoing major noncardiac surgery as a paradigm for these questions. Over the 5-year K24 award period, my goals are to further develop my research program and mentor investigators who will be passionate about these same areas, and who will become successful independent investigators. To achieve this 5 year goal, this K24 has 2 specific aims: (1) to perform patient-oriented research aimed at understanding how hospitalization for noncardiac surgery produces gaps in cardiac medications and how these gaps affect patient outcomes. I will use local and national data to understand how often cardiovascular medications (for example, use of aspirin in patients with coronary artery disease, or angiotensin-converting enzyme inhibitors in patients with congestive heart failure) are missed or dropped in noncardiac surgery patients, and how discontinuity in these medications impacts patient outcomes. (2) To create a mentorship program that will foster the development of patient-oriented researchers interested in improving the quality of care for patients with cardiovascular disease. I will mentor fellows and junior faculty, and diversify my mentorship portfolio to include a greater emphasis on the development of cardiovascular specialists, hospitalists, and subspecialists who have an interest in quality-improvement (or, translating evidence into practice) research as their career goal.